NHS

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Have your say on England’s “gender dysphoria services”

Following hot on the heels of the new Scottish protocol for transition-related services, the Department of Health has published a draft guide for England.

They’re not holding a formal consultation on the document (meaning that it’s not available on the Department of Health website), but are “seeking the views of stakeholders […] to find out if the ‘journey’ outlined in the document reflects the experience transgender people actually have and, where there are differences, what they are.”

This is a really important opportunity for you to offer feedback on the proposed guide to English services.

A copy of the document is available below:

Gender Dysphoria Services – An English Protocol

When you’ve read the document, you can share your views through the following link:

Survey

I’m planning to post my own analysis of the draft protocol when I’ve had time to read through it properly.

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Scotland hands unprecedented power to trans patients

The big news from Scotland today is all about gay marriage. But last week, the Scottish government quietly unveiled an equally important move.

The new NHS Scotland Gender Reassignment Protocol will have a massive impact upon those who seek a medical transition. It dramatically cuts the time required for “real life experience” prior to surgery, confirms the necessity of contested interventions such as hair removal for trans women and chest surgery for trans men, enables teenagers to begin transition from 16, and – crucially – reinforces the right of trans people to refer themselves to Gender Clinics.

Some background
Last year saw the publication of the latest edition of the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC). This seventh edition of the SOC saw a number of important changes that acknowledged critiques from trans communities as well as clinicians, leading to a focus upon gender variant identities and experiences in terms of diversity, rather than pathology.

Treatment is individualized. What helps one person alleviate gender dysphoria might be very different from what helps another person. This process may or may not involve a change in gender expression or body modifications. Medical treatment options include, for example, feminization or masculinization of the body through hormone therapy and/or surgery, which are effective in alleviating gender dysphoria and are medically necessary for many people. Gender identities and expressions are diverse, and hormones and surgery are just two of many options available to assist people with achieving comfort with self and identity. (p.5)

Thus, transsexual, transgender and gender non-conforming individuals are not inherently disordered. Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatments are available. (p.6)

This emphasis upon individual difference and patient agency differentiates this seventh edition of the SOC from previous editions published by both WPATH and its predecessor, the Harry Benjamin International Gender Dysphoria Association. The change follows decades of lobbying from trans activists, academics and progressive professionals. We’ve gone from a world where post-doctoral researchers who happened to be trans – such as Virginia Prince – could publish research only with the approval of cis clinicians, to a world in which trans professionals like Stephen Whittle are setting the agenda.

WPATH are still far from perfect: see, for instance, the fact that they seem to think they are qualified to speak for intersex people. But, broadly speaking, the latest SOC is a definite step in the right direction.

Competing guidance
When WPATH speaks, medical providers don’t necessarily listen. Trans people are often diagnosed according to criteria set out guidance such as the American Psychological Association’s Diagnostical Statistical Manual of Mental Disorders (DSM), which treats us as mentally ill. Gender clinics in the UK often follow previous editions of the SOC, which encourage a patronising, controlling approach in practitioners.

For instance, a recent Freedom of Information request revealed that Leeds GIC “…follows the stages laid down within The Harry Benjamin International Standards of Care (this differs from the WPATH guidance), as we believe that hormone treatment is best undertaken after real life experience has begun…“: i.e. the clinic is relying upon outdated guidance, under which patients are forced to go “full-time” for some time before they are prescribed hormones. This will clearly cause difficulties for individuals who have trouble passing as cis without hormone therapy, and may leave them open to harassment or violence.

Even less regressive GICs in the UK currently do not comply with with the most recent edition of the SOC. This can be seen in the imposition of binary ideals of gender, the absence of treatment protocols for most trans adolescents, and a “real life test” of at least two years before requests for surgery are considered (as opposed to the 12 months recommended in the new SOC).

Of course, any revision of national medical practice takes time, particularly within a public body such as the NHS. Changes to the NHS care pathway in England and Wales are currently under discussion. Moreover, hormone regimes for teenagers are currently being trialled in London. I don’t know enough about the situation in Northern Ireland to write about what’s happening there.

It is against this backdrop that the new Scottish protocol has been introduced.

NHS Scotland Gender Reassignment Protocol: the headlines
The new Scottish guidance has been shaped by trans activists working with key figures within Scottish equality bodies and NHS Scotland. It won’t have an immediate impact upon the availability of services, with implementation being a long, complicated process. However, it is historic in that the published care pathway clearly empowers trans patients in a number of ways.

The Scottish Transgender Alliance highlight a number of important points from the protocol (emphasis mine):

  • people can self-refer to NHS Gender Identity Clinics (GICs) in Scotland.
  • that psychotherapy/counselling, support and information should be made available to people seeking gender reassignment and their families where needed.
  • that two gender specialist assessments and 12-months experience living in accordance with desired gender role are needed for referral for NHS funded genital surgeries and that arrangements for delivering agreed procedures are under review with the objective of ensuring that an effective, equitable and sustainable service is implemented.
  • only one gender specialist assessment is needed for referral for hair removal, speech therapy, hormone treatment and FtM chest reconstruction surgery and that these can take place in an individualised patient-centred order either prior to starting the 12-month experience or concurrently to the 12-month experience.
  • that, in addition to access to genital surgeries, access to hair removal is regarded as essential to provide for trans women and access to FtM chest reconstruction is regarded as essential to provide for trans men.
  • that surgeries which are not exclusive to gender reassignment, such as breast augmentation and facial surgeries, continue to need to be accessed via the Adult Exceptional Aesthetic Referral Protocol but there will be a more transparent and equitable panel process for making funding decisions in such cases.
  • that young people aged 16 are entitled to be assessed and treated in the same manner as adults in terms of access to hormones and surgeries.
  • that children and young people under age 16 are entitled to child and adolescent specialist assessment and treatment as per the relevant section of the WPATH Standards of Care. NOTE: at the time the protocol was created the staffing of a specialist Under 16s service at the Sandyford GIC in Glasgow was uncertain but it now looks likely that there will be a sustainable Under 16s service provided at the Sandyford GIC in Glasgow and this part of the protocol will soon be updated.

As the Scottish Transgender Alliance note, this protocol isn’t perfect, but it does represent an important step forward. If the protocol is properly implemented, trans people will no longer be forced to spend months (or even years) fighting for a referral, before waiting even longer for treatment as a GIC patient. Trans people will be able to access vital interventions such as hair removal on the NHS, and should be able to access proper counselling and therapy services.

A personal perspective
If a protocol such as this had been in place in England when I came out as a teenager, I could have gained a referral (or even referred myself!) to a GIC at the age of 16. Even with the massive waiting list for the GIC, I might have been on hormones at 17, and had surgery at 18. I wouldn’t have had to undergo anything like so many painful laser hair removal sessions, and those that I did undergo would have been paid for by the NHS.

Instead, my first GIC appointment was at the age of 19. I didn’t go on hormones until I was 20 (causing all kinds of havoc with my university grades during my final year as I underwent a second puberty) and had surgery shortly before my 22nd birthday. I paid for several laser hair removal sessions privately. One day I hope to afford a few more, as I never finished that particular treatment.

And I’m one of the lucky ones.

The future
I can’t really understand why this isn’t already all over the LGBT press, let alone the trans blogosphere. It’s a deeply important development.

The progressive nature of the new Scottish protocol provides a positive precedent for the rest of the UK. We can only hope that NHS protocols for England and Wales and for Northern Ireland follow suit. In the meanwhile, trans activists throughout the UK could do well to pay close attention to the situation in Scotland. The success of organisations such as the Scottish Transgender Alliance provide important lessons for the rest of us.

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Student medics push for trans on the curriculum

We seem to be quietly creeping towards a better situation for trans health.

There’s clearly a major problem. The Home Office’s informal e-surveys of trans experience indicated that the realm of “health” is a key concern for a great many of us, with almost half of respondents saying that they did not think their GP was doing a “good” or “excellent” job in addressing their health needs. Meanwhile the 2007 Engendered Penalties report (created by Press For Change for the Equalities Review) notes that 1 in 6 of respondents reported experiencing discrimination from medical professionals.

Issues of health access aren’t limited to those problems created by the referral and treatment process for medical transition. Many of us are still being treated inappropriately because we are trans, regardless of what treatment we’re seeking at any given time.

It’s heartening then to (finally!) see increasing willingness to do something on the part of medical professionals. Zoe O’ Connell describes the positive outcomes of a recent meeting between trans activists and the General Medical Council. And at the other end of the professional “scale”, last week saw the publication of an article in the Student Lancet calling for teaching on trans issues within the medical curriculum.

The Lancet article isn’t the intervention of one isolated student medic. Its author informs me that there is widespread anger (yes, anger!) about the lack of LGBT material on the curriculum amongst her peers at Warwick Medical School. They’re particularly unimpressed with how trans people are treated. The students in question feel they should be taught properly about all issues they might encounter as doctors, and are taking action to ensure this actually happens.

“The staff-student liaison committee reps in my year have decided they want to push having teaching on LGB and especially T stuff added to the curriculum,” explains my informant. “I bashed out a quick petition over breakfast and floated it round my lecture theatre to collect signatures for them so they had a bit more clout – so they now have a petition signed by over half of my cohort telling them they should be teaching trans stuff.”

Of course, this is just one small step towards the provision of appropriate health services for trans people. As the Student Lancet article concludes:

“I feel that this is a change which is urgently needed at an institutional level rather than at the level of individual medical schools. Only by taking a unilateral approach will we ever manage to change the perception of the NHS as a discriminatory institution. In order to effectively treat transgender individuals we need to prove to them that we are worthy of their trust.”

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Save the NHS: Block the bridge, block the bill

UK Uncut are planning an unprecedented act of civil disobedience at 1pm on Sunday 9th October in protest against the government’s NHS reforms. Over one thousand people have already announced their intention to participate in the action, which aims to demonstrate the level of public opposition to the Bill and put pressure on sympathetic peers in the House of Lords by occupying Westminster Bridge.

The activist group are also encouraging people to contact peers and ask them to block the bill.

Full details of the demonstration can be found on the UK Uncut website.

There is also a Facebook event page.

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Save the NHS, part 2: lobby the Lords

The NHS “reform” bill passed the Commons on its third reading yesterday by 316 votes to 251.* It will now go to the Lords for further scrutiny.

It’s not too late to save the NHS. A number of groups are recommending an unprecedented public lobby of the Lords in order to stop (or at least fundamentally alter) the bill.

The TUC have set up a page to help you do this: Adopt a Peer.

There is also a Facebook page with a fair bit of information.

 

“This is really important. I don’t think anyone has ever engaged en masse with members of the upper house on an issue like this before. They don’t have constituencies, and they can’t be voted out at an election. Nevertheless, many peers cherish their role in scrutinising bad legislation. They need to know there is a widespread dislike for these changes.”

– Christine Burns

*A grand total of four Liberal Democrat MPs voted against the bill. I can’t comprehend why anyone who cares about public services would ever want to vote Lib Dem again. May the party crash and burn come the next election.

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ACT NOW to save the NHS

MPs are currently debating the controversial NHS reform bill. The £2 billion re-haul of our health system will be voted upon after just two days of debate in Parliament in spite of Conservative promises to oppose any “top-down” reorganisation of the NHS. Lawyers have warned that the changes will fundamentally undermine political accountability and further privatise the health system.

We’ve currently got one of the most economically efficient health systems in the world. It’s hardly perfect – and indeed, I strongly believe that the the NHS benefits from criticism – but we’re incredibly lucky to have it.

This is your chance to tell MPs that we can’t and won’t accept them messing with our health system.

Take action now:

Call your MP (via 38 Degrees)

Email your MP (via 38 Degrees)

Sign the e-petition (HM Government e-petition site)

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Protect the NHS

Opposition to the government’s ill-conceived NHS reforms is growing. I wrote an angry post about the issue last year, but the argument against the proposals is perhaps best summed up in this video by MC Nxtgen:

Co-ordinated protests are apparently taking place across the UK today, but I haven’t seen much in the way of media coverage on the issue so far. We need to be raising awareness of the issue ourselves and building opposition as a broad movement.

I’m always in favour of a good demonstration, but armchair activism also has its place. As such, here’s a couple of initiatives from 38 Degrees (who were in part responsible for the government’s U-turn on the sale of state-owned forests).

“Save The NHS”: petition

Email your MP

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(Guest Post) Turn and Face the Strange

The following was written by Louis, who recently experienced an appointment with “Dr Jiff” that unfolded pretty much as outlined.


“But let me tell you, this gender thing is history. You’re looking at a guy who sat down with Margaret Thatcher across the table and talked about serious issues.”
– George H. W. Bush

One morning, as I awoke from anxious dreams, I discovered that in my bed I had been transformed into exactly the same body as I had been the night before.

Examination of my whole organic structure proved this to be true, and as my mother greeted me normally in the kitchen, my feeling of de-centralised horror was crystallised. Most people, upon waking to find themselves the same, would find reassurance in the stability of their own identity – unchanged by the nights stargazing. To the average man or woman, the roaming of a well-gendered mind at rest is a pleasure. I, however, on that morning, realised that my unprecedented disquiet was the beginning of something. I was right. I have not been quite at home with myself since.

Psychology today is a noble hobby, halfway between a humanity and a science. I tend to lean towards the side of art.

On the 9th December, 2010, I find myself sitting in the office of Dr Jiff in University Hospital Coventry. It’s the psychiatric clinic. I’ve spent half an hour waiting outside, before being beckoned, with a smile, into this room, where I am to give the performance of my life. My part: Myself, as the National Health Service wants to see me. The office is large and sparse, with high, grey windows and navy blue carpet. It’s warm, however, and my chair is comfortable. Not a couch, but a plain lavender seat by the doctor’s desk. Dr Jiff himself is something of a surprise. After all I’ve heard, here is a man in his twilight years: rotund, moustached, with yellow sweat patches under his arms. A fair tie, mind you – M&S perhaps.

He has an affable face, and is delightfully frank in all things… though as usual for a psychiatrist, his eyes are mirrored walls. This is our first meeting. As I write, I expect many more: my performance this day is a surprising success.

To begin to understand the nature of my madness, I would first have to explain what madness actually is, in a social context at least. I’m sure you have your own ideas on the matter, but here’s my take on the state of things. Madness is a state of mind which society as a whole (or perhaps the ideal that society projects of itself, and never seems to actually get to) finds to be outside the bounds of “normal”. Sometimes madness is considered genius. Sometimes geniuses go mad. More often than not, madness is considered a rather dangerous or undesirable thing to have around. The more cutting amongst you may have noticed that I didn’t define what “normal” is. That’s because I truly have no idea.

In Psychology and Psychiatry, different kinds of madness are categorised and given different names. The name for my particular type of madness is Gender Dysphoria. It has an average occurrence, according to the NHS, of about 1 in every 4000 people in the UK – though it is important to note that these are only those individuals seeking treatment. Estimates have been made suggesting that 1 in every 1000 people may experience gender dysphoric feelings, or even 1 in every 120. Some psychiatric organisations have suggested that there are perhaps 500,000 gender dysphoric people in the UK, and 10,000 who have successfully asked for, and received, treatment. Statistically speaking, you’ve probably met at least 3 people with some level of gender dysphoria within the last 5 years of your life. Whether or not you were aware is a moot point.

The treatment of my disorder is seen with some contempt by the general populace – it requires the breaking of ancient rules of civilisation. This sounds more exciting than it really is. In day to day life, I’m perpetually astonished by how seriously people take gender labels, and how violently they will react against those individuals who wish to put their hand up halfway through the lesson, and say “Excuse me, I think you got that bit wrong.”

On the 19th of August 1992, a gender dysphoric person was removed surgically from its mother’s stomach and placed (screaming, purple and bloody) into the world, possessing all the appearance of female genitalia. Because of this, a somewhat tenuous, but deeply historic and traditional, social categorisation was made, and it was assigned the gender role of “female”. However, the gender label which it now identifies with, if it has to at all (and that is a whole other debate), is “male”. Some people interpret this in the following way:

“She wants to be someone else” OR “She wants to be a man.”

A gender dysphoric person find this degrading and frustrating. As far as they are concerned, they have always been the same person, and will always be the same person, in one form or another. I summarise the following:

“He is a man, and if society wishes to hang so much meaning and status on gender pronouns – a figment of language no less – then it can at least have the decency to let people identify themselves, rather than thrusting identity upon them at a stage where they can’t argue back.”

Dr Jiff’s office, on the 9th of December, is a pleasant change from the usual hostility. To begin with, he has assured me that there are “unlikely” to be any problems in my referral. I explain the issues I have had when trying to achieve this in the past, and he shrugs off the ignorance of some in his profession with a simple:

“Some people just don’t go to enough conferences.”

Then:

“Do you masturbate?”

(Don’t tell me that wouldn’t knock you off balance a bit.)

“Yes.”

“Any particular fantasies?”

“Hmm.” I pull the face which I always pull when planning to politely lie. “No, just generic men.”

(Really, I have an imagination.)

“How do you identify – put into words?”

“Gay male, polyamorous.”

“Do you dream in colour or black and white?”

“Colour.”

“How do you place yourself within your dreams?”

(I want to say ‘the victim’, but I don’t.)

“Omnipresent.”

“And male or female?”

“I don’t see.”

“Any suicidal tendencies?”

“Nothing unusual. I saw a counsellor, it’s all in my notes and over with.”

And so on.

This stream of banal, sometimes cryptic, often probing questions, will determine the course of the rest of my life. In the end I “perform” so well that I achieve the referral and more: a fast track to a new clinic, with treatment as good as guaranteed in 3 months. The gatekeeper has been defeated. Apparently, the land of maleness is mine for the  exploration, chatting-up, styling, drawing, eating, sucking, dressing, drinking, writing, injecting, rubbing, wanking, fucking, and taking. And the clothes. I’ll be able to wear a pair of trousers on hips that aren’t just-too-wide, and a suit tailored to fit a new figure – simple pleasures hard won. Why choose soft curves when you can have hard lines? I know which I find easier to follow. But I digress.

“What do you know about the surgical options?” Doctor Jiff asks.

“First you have to ‘live the life’ for 2 years.”

“Yes that’s right, how long’s it been for you now?”

“2 months. Facebook proves it.”

“Good. And what were you considering?”

“Phalloplasty looks generally crap. I want top-surgery though.”

“Yes. The success rates for breast reduction and removal are excellent. How big are your boobs?”

(I can’t describe the impact of words like ‘boobs’ leaving this man’s lips.)

“Small.”

“Well it will be a question of finding the right surgeon, but I can help you.”

“Thanks.”

“Phalloplasty, though, is a tricky one. In 2 years time when you’re eligible, things may have changed completely, but at the moment it’s a poor sport. What you really want is to be able to feel and to experience, which as things stand in the field is not particularly attainable, so unless you suddenly become desperate for a penis, it’s worth avoiding for now. I mean, can you have a really good orgasm with what you’ve got?”

“…Yes.”

“Then that’s good, and anyway, there are things you can do with a strap-on, especially anally, that just can’t be done by natural men.”

(It’s only after I leave the room that it occurs to me to laugh and laugh.)

The question of my sexuality is only mentioned in passing. I have heard several, interesting viewpoints on it. My good friend L___ was rather surprised when I suggested that there was any problem. “But 80% of the female population are straight,” he argued, “So surely 80% of transmen are gay? It’s just logic.” I thanked him for this excellent piece of reasoning.

Others, however, have been less supportive. The first psychiatrist I saw to try and obtain a referral was quite obstinate in her belief that a transman couldn’t possibly be gay, because all transmen must surely be lesbians who just couldn’t face up to their sexuality. “I like anal sex,” I told her, just for the hell of it. She didn’t appreciate that. Of course, there lies another minefield of debate: my under-eighteens counsellor pointed out that with my total lack of sexual  experience of any kind, how could I possibly know what I was attracted to? This, to me, seems like a rather foolish question, and leads me to assert a rather controversial fact:

Nobody knows a person as well as they know themself.

That point made, it is interesting to note the breadth of reactions that a trans or gender dysphoric person may receive in their exploration of this idea. Imagine meeting someone you have known since infancy for coffee. The two of you make small talk and enjoy each other’s company, then out of the blue, your friend tells you that they have to say something important: they are not really brunette at all, they are actually blonde. To the evidence of your own eyes, this is ridiculous, and you say so. No, they explain, the brown is dye. I’ve been covering this up for my whole life.

Of course, hair colour is a somewhat less mind-bending issue than gender, but the premise is similar. Imagine the same conversation, but instead your friend reveals that they are homosexual. This is slightly more controversial. To   someone like me it doesn’t matter at all, but of course to many people, this is a genuinely world-altering piece of information. Now, imagine your friend putting down their coffee cup, and telling you that they are actually the opposite gender.

Imagine walking away with that information in your mind.

Surely you know them better than that? Don’t you?

If you need to stick a label on them to understand them, do you really know them at all?

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What’s in a consultation?

The media is currently getting itself into a massive tizzy over government proposals to allow gay couples to have civil partnerships in religious buildings. The predictable right-wing wonks are being wheeled out to moan about it being a slippery slope that will end up with any given Christian priest (no-one cares about what Jews, Muslims or (God forbid) Pagans might think, it seems) being forced to marry a couple of scary gay men with Nazi tattoos.

Meanwhile, left-leaning and right-leaning papers are falling over themselves to predict that full gay marriage (and, weirdly, heterosexual civil partnership) will be next, despite the fact that there has been no confirmation of this from anyone in government. I mean, let’s take a look at the actual statement from the equalities minister, Lynne Featherstone:

“Over the past few months I’ve spoken to a lot of lesbian, gay, bisexual and transgender people and campaign groups, and it quickly became clear that there is a real desire to address the differences between civil marriage and civil partnerships. I’m delighted to announce that we are going to be the first British government to formally look at what steps can be taken to address this.”

Yep, there’s certainly a lot in there confirming that gay marriage is around the corner. I’m hoping that it will be (hell, we could immediately take the next logical step and start pushing for legal recognition of polyamory or something!) but have my doubts. After all, the Tories aren’t really that keen on gay marriage. The Liberal Democrats have policy on it and Nick Clegg says that he’s in support, but if you can’t trust the Lib Dems on student fees, trident, detention policies, supporting the poor, the disabled, women or just about anyone else really, then I’m not convinced that you can trust them on equal marriage either.

Moreover, there’s that little issue of the consultation. Government consultations can take forever! I first started campaigning on amendments to the proposed Single Equality Bill (as it was then) back in 2007, and the first consultation was held well before then. The Equality Act eventually emerged in 2010 after being rushed through at the last minute by a desperate Labour party. Ben Summerskill of Stonewall has (for a change) made a pertinent point relating to this:

“If there’s a genuine commitment to making progress in this area, it is painfully slow. Equalities minister Lynne Featherstone has explicitly said she would consult on proposals the government intends to implement in the lifetime of this parliament. If that is to happen by 2015, then consultation should begin now.”

I’d take his word for it: Summerskill knows a thing or two about just how “painfully slow” progress on equal marriage can be.

So this will probably take some time. But it’s interesting that whilst this particular consultation is likely to take ages as civil servants painstakingly gather the views of any given bigot at hand, another important consultation is little more than a formality.

The government is still planning to radically reinvent the NHS despite massive opposition from those who actually understand our health service and care about the welfare state. The “consultation” on this has been minimal to say the least, and health services have already had to start preparing for changes that may have a huge negative impact upon service provision for some of the most vulnerable people.

Funny that the government is so keen to hold a consultation on religious civil partnerships when the relevant law is already there (as part of the Equality Act), but is happy to push ahead with its NHS clusterfuck with as little input from others as possible. Draw your own conclusions.

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Why the NHS shake-up leaves me baffled

If you live here in England, you’ve probably noticed that the government has decided to give £80 billion of public money to GPs (read: private companies working with GPs) and scrap primary care trusts. David Cameron claims “We are not reorganising the bureaucracy, we are scrapping the bureaucracy.”

One of my biggest problems with the NHS is that the bureaucracy of the health system is incredibly unwieldy. All too often the left hand doesn’t seem to know where the right hand even is, let along what language it speaks. I’m also usually in favour of devolution and the localisation of services. I can’t conceive of how this particular change will be an improvement though.

We currently have 150 primary care trusts (PCTs) and the government is proposing to replace them with between 500 and 600 GP consortia – in order to save money. Surely though the cost of doing this in the first place is going to be ridiculous?

Surely this move will do nothing to remove the NHS bureaucracy: it’ll just shift it from (publicly owned) PCTs to (privately-owned, but publicly funded) consortia. This will mean that thousands upon thousands of people working in admin will lose their jobs…and thousands of new jobs will be created elsewhere. It’s being claimed that individuals who currently work for a PCT could seek work with a consortium but…this is just stupid. Thousands of admin workers will basically be relocated to new bodies, and this is going to cost a huge amount of money: it’ll cost to close down the PCTs, it’ll cost to make redundancies, it’ll cost to advertise for the new jobs and to run interviews and to basically re-train pretty much all of the non-hospital admin staff for the NHS in England. What planet is Andrew Lansley living on?

Additionally, each PCT tends to have its own individual policies, guidelines, patient booklets and outreach/advertising schemes for various services. It costs money to produce all of this: surely it’s going to cost more money for 500+ variations on a theme than 150?

Okay, so suppose the government is right about how best to save money whilst providing better services on the NHS (hah!) and all of the above will be cancelled out by the long-term savings. How easy will it be to hold all of this hundreds of these new consortia to account?

A few days ago I posted up a new policy for trans name changes we’ve sorted out with the local PCT. Within three years that change is probably going to be a bit pointless, and I won’t be surprised if things regress within the Coventry area. There’s a lot of very decent GPs out there, but others aren’t: a bunch of them are bigoted arseholes who will deny treatment to LGBTQ people at the drop of a hat. If GPs are going to be responsible for deciding who gets funding and hospital referrals, trans people who seek medical treatment could be in a lot of trouble. I’m not just talking about trans people who want to transition medically: I’m talking about any trans person who wants any kind of treatment, since the whole “we don’t serve your kind here” attitude is still highly prevalent. Of course, under current rules the NHS as a whole in the UK has to provide treatment (including aspects of medical transition) for all trans people, but that hasn’t stopped certain areas (such as, say, Wales)  from refusing to provide treatment.

Right now, if we’re lucky enough to have the PCT on our side (as we finally do in Coventry…tentatively, at least) then we can have them pressure the GP to sort it out. This system is far from perfect, since many PCTs simply don’t want to listen (see: Oxfordshire) but I imagine it’s going to be far harder to bring about positive social change in five or six local consortia than it is with a single PCT.

Moreover, one of the biggest problems with the NHS is communication. One of my friends was given a referral to Charing Cross gender clinic by a psychiatrist after years of waiting, but then had to move house and ended up in a different PCT. The PCT refused to acknowledge the referral and made her start again from scratch, effectively postponing her access to hormones by two years. I can’t imagine that this kind of thing will be less common with the NHS split up into more bodies.

So what can we do? Well, I suspect there’s very little we can do, but now is the time to act. We should be fighting on every front: writing to politicians, talking to the media, participating in protests and taking part in any consultation event we can find out about, and at every stage we should be asking awkward questions about how these changes will impact minority groups such as trans people (‘cos I’m pretty certain it will disproportionately screw over others, such as people living in poorer areas).

Finally, a couple of thoughts from The Guardian:

GPs are doctors, not accountants

“Imagine this bedpan is full of money…”